Case report of hepatic artery dissection secondary to hepatic artery pseudoaneurysm after living donor liver transplantation


Background:
Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after LDLT, which was diagnosed and followed for one year by ultrasound. To the best of our knowledge, few studies have reported similar cases after liver transplantation in the English literature.

Case presentation:
A 43-year-old man underwent right-lobe LDLT for treatment of a severe acute hepatitis B infection and was followed up with ultrasound examinations for one year. Conventional gray-scale and Doppler ultrasound combined with contrast-enhanced ultrasound (CEUS) accurately revealed the occurrence of HA dissection secondary to HAP and accompanied by thrombosis and collateral circulation, as well as secondary biliary complications, which provided a prompt diagnosis and guidance for the treatment.

Conclusion:
Our case suggests that ultrasound can help detect hepatic artery pseudoaneurysm and dissection, as well as secondary biliary lesions after LDLT in an accurate and timely manner and provide useful information for the treatment chosen. CEUS shows potential as an important complementary technique to gray-scale and Doppler ultrasound.

Keywords:
Hepatic artery pseudoaneurysm, Dissection, Living-donor liver transplantation, Ultrasound, Contrast-enhanced ultrasound


Autoři: Lin Ma 1;  Kefei Chen 2;  Qiang Lu 1;  Wenwu Ling 1;  Yan Luo 1*
Působiště autorů: Department of Ultrasound, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, Sichuan Province 610041, China. 1;  Department of liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China. 2
Vyšlo v časopise: BMC Gastroenterology 2016, 16:44
Kategorie: Case report
prolekare.web.journal.doi_sk: 10.1186/s12876-016-0458-8

© 2016 Ma et al.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-016-0458-8

Souhrn

Background:
Hepatic artery pseudoaneurysm (HAP) and Hepatic artery dissection are rare vascular complications after living donor liver transplantation (LDLT), which may lead to graft loss and death of the recipients. Conventional gray-scale and Doppler ultrasound, as well as contrast-enhanced ultrasound (CEUS), play important roles in identifying vascular complications in the early postoperative period and during follow-up. We report a case of hepatic artery dissection secondary to HAP after LDLT, which was diagnosed and followed for one year by ultrasound. To the best of our knowledge, few studies have reported similar cases after liver transplantation in the English literature.

Case presentation:
A 43-year-old man underwent right-lobe LDLT for treatment of a severe acute hepatitis B infection and was followed up with ultrasound examinations for one year. Conventional gray-scale and Doppler ultrasound combined with contrast-enhanced ultrasound (CEUS) accurately revealed the occurrence of HA dissection secondary to HAP and accompanied by thrombosis and collateral circulation, as well as secondary biliary complications, which provided a prompt diagnosis and guidance for the treatment.

Conclusion:
Our case suggests that ultrasound can help detect hepatic artery pseudoaneurysm and dissection, as well as secondary biliary lesions after LDLT in an accurate and timely manner and provide useful information for the treatment chosen. CEUS shows potential as an important complementary technique to gray-scale and Doppler ultrasound.

Keywords:
Hepatic artery pseudoaneurysm, Dissection, Living-donor liver transplantation, Ultrasound, Contrast-enhanced ultrasound


Zdroje

1. Pérez-Saborido B, Pacheco-Sánchez D, Barrera-Rebollo A, Asensio-Díaz E,Pinto-Fuentes P, Sarmentero-Prieto JC, et al. Incidence, management, and results of vascular complications after liver transplantation. Transplant Proc. 2011;43:749–50.

2. Hom BK, Shrestha R, Palmer SL, Katz MD, Selby RR, Asatryan Z, et al. Prospective evaluation of vascular complications after liver transplantation: comparison of conventional and microbubble contrast-enhanced US. Radiology. 2006;241:267–74.

3. Vit A, De Candia A, Como G, Del Frate C, Marzio A, Bazzocchi M. Doppler evaluation of arterial complications of adult orthotopic liver transplantation. J Clin Ultrasound. 2003;31:339–45.

4. Jiang XZ, Yan LN, Li B, Zhao JC, Wang WT, Li FG, et al. Arterial complications after living-related liver transplantation: single-center experience from West China. Transplant Proc. 2008;40:1525–8.

5. Khalaf H. Vascular complications after deceased and living donor liver transplantation: a single-center experience. Transplant Proc. 2010;42:865–70.

6. Leelaudomlipi S, Bramhall SR, Gunson BK, Candinas D, Buckels JA, McMaster P, et al. Hepatic-artery aneurysm in adult liver transplantation. Transpl Int. 2003;16:257–61.

7. Asonuma K, Ohshiro H, Izaki T, Okajima H, Ueno M, Kodera A, et al. Rescue for rare complications of the hepatic artery in living donor liver transplantation using grafts of autologous inferior mesenteric artery. Transpl Int. 2004;17:639–42.

8. Crowhurst TD, Ho P. Hepatic artery dissection in a 65-year-old woman with acute pancreatitis. Ann Vasc Surg. 2011;25:386. e17–21.

9. Low G, Crockett AM, Leung K, Walji AH, Patel VH, Shapiro AM, et al. Imaging of vascular complications and their consequences following transplantation in the abdomen. Radiographics. 2013;33:633–52.

10. Singh AK, Nachiappan AC, Verma HA, Uppot RN, Blake MA, Saini S, et al. Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 2010;30:339–51.

11. Roberts JH, Mazzariol FS, Frank SJ, Oh SK, Koenigsberg M, Stein MW. Multimodality imaging of normal hepatic transplant vasculature and graft vascular complications. J Clin Imaging Sci. 2011;1:50.

12. Caiado AH, Blasbalg R, Marcelino AS, da Cunha PM, Chammas MC, da Costa LC, et al. Complications of liver transplantation: multimodality imaging approach. Radiographics. 2007;27:1401–17.

13. Crossin JD, Muradali D, Wilson SR. US of liver transplants: normal and abnormal. Radiographics. 2003;23:1093–114.

14. Tamsel S, Demirpolat G, Killi R, Aydin U, Kilic M, Zeytunlu M, et al. Vascular complications after liver transplantation: evaluation with Doppler US. Abdom Imaging. 2007;32:339–47.

15. Luo X, Tan S, Wang J, Qian C. Upper gastrointestinal hemorrhage from hepatic artery pseudoaneurysm secondary to trauma: a case report. Med Princ Pract. 2010;19:493–5.

16. Marshall MM, Muiesan P, Srinivasan P, Kane PA, Rela M, Heaton ND, et al. Hepatic artery pseudoaneurysms following liver transplantation: incidence, presenting features and management. Clin Radiol. 2001;56:579–87.

17. Maleux G, Pirenne J, Aerts R, Nevens F. Case report: hepatic artery pseudoaneurysm after liver transplantation: definitive treatment with a stent-graft after failed coil embolisation. Br J Radiol. 2005;78:453–6.

18. Luo Y, Fan YT, Lu Q, Li B, Wen TF, Zhang ZW. CEUS: a new imaging approach for postoperative vascular complications after right-lobe LDLT. World J Gastroenterol. 2009;15:3670–5.

19. Matsuo R, Ohta Y, Ohya Y, Kitazono T, Irie H, Shikata T, et al. Isolated dissection of the celiac artery–a case report. Angiology. 2000;51:603–7.

20. Lin TS, Chiang YC, Chen CL, Concejero AM, Cheng YF, Wang CC, et al. Intimal dissection of the hepatic artery following transarterial embolization for hepatocellular carcinoma: an intraoperative problem in adult living donor liver transplantation. Liver Transpl. 2009;15:1553–6.

21. Fontanilla T, Noblejas A, Cortes C, Minaya J, Mendez S, Van den Brule E, et al. Contrast-enhanced ultrasound of liver lesions related to arterial thrombosis in adult liver transplantation. J Clin Ultrasound. 2013;41:493–500.

22. Potthoff A, Hahn A, Kubicka S, Schneider A, Wedemeyer J, Klempnauer J, et al. Diagnostic value of ultrasound in detection of biliary tract complications after liver transplantation. Hepat Mon. 2013;13:e6003.

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Gastroenterológia a hepatológia
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